Clase IIa
1. Pretratamiento con amiodarona, flecainida, ibutilide, propafenona o sotalol puede ser utilizado para
incrementar el éxito de conversión a sinusal en cardioversión eléctrica y prevenir la recaída (nivel de evidencia B).
2. En pacientes con recaída de fibrilación auricular posterior a cardioversión farmacológica exitosa, puede ser usada una medicación antiarrítmica previa a un nuevo intento de cardioversión (nivel de evidencia C).
Clase IIb
1. Para pacientes con fibrilación auricular persis- tente, la administración de betabloqueadores, disopiramida, diltiazem, dofetilide, procainamida o verapamilo puede ser considerada, aunque la eficacia de estos medicamentos para prevenir la recaída de fibrilación auricular poscardioversión eléctrica es in- cierta (nivel de evidencia C).
2. Extrahospitalariamente, la administración de me- dicamentos antiarrítmicos para incrementar el éxito de la cardioversión eléctrica, puede ser considerada en pa- cientes sin enfermedad cardíaca estructural (nivel de evidencia C).
3. Extrahospitalariamente, la administración de me- dicamentos antiarrítmicos para incrementar el éxito de la cardioversión eléctrica, puede ser considerada en pa- cientes con algunas formas de enfermedad cardíaca, una vez el medicamento ha sido utilizado con seguridad en el paciente (nivel de evidencia C).
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Tabla 1
PRETRATAMIENTO EN CARDIOVERSIÓN DE PACIENTES CON FIBRILACIÓN ATRIAL PERSISTENTE: EFECTIVIDAD DE VARIOS ANTIARRÍTMICOS
Eficacia Conversión y prevención de RIFA Supresión RSFA y mantenimiento Recom Evidencia
Probada Amiodarona Todas en recomendación I (excepto ibutilide) I B
+ BB Flecainida Ibutilide Propafenona Quinidina Sotalol
Incierta Betabloqueadores Diltiazem IIb C
Diltiazem Dofetilide
Disopiramida Verapamilo
Dofetilide Procainamida Verapamilo
RIFA indica Recaída inmediata de FA, RSFA recaída subaduga, BB betabloqueador. Todas excepto amiodarona y betabloqueadores se deben iniciar intrahospitalariamente.
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